The Heart of the Matter

Understanding the risks and symptoms of heart disease in women

Many people mistakenly assume that heart disease is just a men’s health issue. Yet heart disease also ranks as the number one killer of American women. According to the American Heart Association, coronary heart disease is responsible for 35 percent of all deaths in women – more than all types of cancer combined, including breast and lung cancer.

“Women often aren’t aware of their risk factors for cardiovascular disease, including heart disease,” says Sophie Barbant, M.D., a cardiologist at the St. Luke’s Cardiovascular Center.

“Overall, women’s risk factors are similar to those for men – including age, family history, obesity, high cholesterol, high blood pressure, lack of exercise and smoking,” she explains. “There are some important differences, though. Low blood levels of HDL – the ‘good’ cholesterol – are more associated with cardiac disease in women than in men. In addition, high blood levels of molecules called triglycerides and lipoprotein (a) appear to be stronger predictors of heart disease in women than in men. Type 2 diabetes may also be a stronger contributing risk factor for women.”

Barbant notes that some risk factors, such as age and family history, are beyond a woman’s control.

“Menopause is another risk factor you can’t control,” she says. “Heart disease in women is unusual before menopause, particularly in the absence of other risk factors. We don’t fully understand why that is the case. Researchers used to think it was because estrogen protected the heart, but recent studies don’t show any beneficial effect of hormone replacement therapy in reducing heart disease.”

Women suffering a heart attack also may experience a range of other symptoms unrelated to heart pain, including

nausea and dizziness

pain in the shoulder and upper back

atypical pain in the stomach or abdomen

unexplained weakness or overwhelming tiredness

cold, sweaty skin and paleness

swelling of the ankles or lower legs

Risk factors related to lifestyle, such as lack of exercise, poor eating habits and smoking are another matter. “You really can control the risk factors associated with lifestyle choices,” Barbant emphasizes. “For example, smoking has been associated with nearly half of all coronary events in women. Even one cigarette per day actually puts you at risk.”

Women’s symptoms of heart disease, including heart attacks, often differ from men’s, too.

“Women are less likely to have ‘typical angina’ – which is chest pain after exercise that can be relieved by nitroglycerin,” Barbant says. “With a heart attack, women don’t always experience a crushing pain in the chest. A study published in 2006 in the American Journal of Cardiology showed that women who had heart attacks described their chest pain as more sharp and burning, accompanied by other pain in the neck and throat.

“There is no explanation, so far, for why women have different symptoms of heart disease and heart attacks than men,” Barbant acknowledges. “The important thing is that if a woman experiences any of these symptoms, or any sign of chest pain or a sense of an irregular heart beat, she should consult a physician right away.

“Don’t make the false assumption that your symptoms could not possibly be heart-related,” she adds. “Insist on being tested for heart disease. It’s your heart – and your life.”